Nurses are the largest segment of the health-care workforce, and nursing is the most-trusted profession in America, according to annual polls. Yet studies have found that nurses feel disrespected and powerless in their profession, and nearly a third leave their job within the first year.

“Nurses are an essential part of our health care system, but they continue to struggle to define what they do and their role in the organizational structure,” said Washington State University doctoral student Tullamora Diede.

Diede said she was moved to study professional identity based on her experiences as a nurse and as a certified clinical nurse leader. And now seems like an ideal time to consider the role of nurses in the health care profession, she said during her doctoral dissertation defense at the WSU College of Nursing.

“I think it aligns well with many of the social justice movements going on,” she said, such as #TimesUp and #MeToo. “People are talking about industries and how women are treated in the workplace.”

Given that the median age of working nurses is 50, the industry needs to address perception issues to continue to attract younger workers, she said.

Diede’s research targeted working RNs in Washington, and she identified a group that had anywhere from one to 41 years of experience. Through interviews, she sought to interpret their experience to identify themes and patterns.

The interviews revealed four main patterns that will be familiar to any nurse:

*The need to be validated and trusted as an expert by people with more power in the organization’s hierarchy;The importance of teamwork;

*Advocating for patients’ needs, especially in the face of opposition by other personnel or by organizational rules;

*And recognizing and valuing the humanity of nursing – the “invisible work” that goes into forming relationships with patients and their families

Diede said her research has implications for practice, education, and policy. Employers could support the time nurses spend with patients and families, for example, and include nurses on governance committees and in decision-making positions. And nursing schools could teach effective communication skills that will help nurses in the workplace.

The payoff, she said, is that studies have shown nurses who perceive themselves as empowered in the workplace have better patient outcomes and patient satisfaction scores.